February 17, 2026
Fraud teams identify $4.3 million in fraud and abuse
At Texas Mutual, we’re dedicated to protecting our policyholders’ premium dollars and the state’s workers’ compensation system. That’s why we have a zero-tolerance policy for fraud. Our team of dedicated investigators works hard to stop bad actors from taking advantage of the system.
In 2025, our special investigations department received 1,606 referrals and identified more than $4.3 million in fraud and abuse. We estimate our work helped prevent over $10.8 million in fraud and abuse. While not all investigation results rise to the level of fraud, our team reports and acts on abuse as well. Read more about the work of our three fraud teams below.
Claimant fraud
Claimant fraud occurs when an employee fails to report they’ve returned to work, falsifies an incident or falsifies the severity of their injuries. In 2025, we reviewed 1,315 referrals for claimant fraud.
Investigation highlights:
- Discovered overpayments due to fraud on 126 cases
- Identified $672,178 in claimant fraud and abuse
- Prevented an estimated $6.3 million in payments to dishonest claimants
Our claimant fraud team also prepared cases that led to two convictions in 2025.
CLAIMANT FRAUD |
|||
|
|
2023 | 2024 | 2025 |
|---|---|---|---|
|
Fraud & abuse identified |
$723,836 |
$965,114 |
$672,178 |
|
Restitution & recoveries |
$358,002 |
$450,016 |
$289,712 |
|
Future savings |
$2,533,643 |
$2,783,626 |
$6,331,545 |
|
Indictments |
1 |
1 |
0 |
|
Convictions |
1 |
1 |
2 |
Health care fraud
Health care fraud can happen when medical providers bill the insurance carrier for services never provided, overbill for services or provide excessive treatment. In 2025, our health care fraud team saved $461,000 through specialized audits on medical bills from providers under investigation.
HEALTH CARE FRAUD |
|||
|
|
2023 | 2024 | 2025 |
|---|---|---|---|
|
Fraud & abuse identified |
$1,405,899 |
$1,396,018 |
$556,168 |
|
Restitution & recoveries |
$236,160 |
$108,716 |
$53,790 |
|
Future savings |
$8,406,017 |
$2,331,119 |
$4,426,004 |
|
Fraud & abuse prevented |
$3,090,371 |
$1,180,977 |
$460,726 |
Premium fraud
Premium fraud is when an employer misrepresents their business operations and payroll to the insurance company to pay a lower premium. Using this fraud scheme could give an employer an unfair advantage over competitors. It could also negatively affect everyone involved in the workers' compensation system. Our premium fraud team identified almost $2.8 million in fraud and abuse in 2025.
Our premium fraud team also prepared cases that led to two convictions in 2025, one of which resulted in $800,000 in restitution to Texas Mutual.
PREMIUM FRAUD |
|||
|
|
2023 | 2024 | 2025 |
|---|---|---|---|
|
Fraud & abuse identified |
$7,624,521 |
$5,956,450 |
$2,773,359 |
|
Restitution & recoveries |
$958,402 |
$4,124,502 |
$2,540,554 |
|
Indictments |
0 |
3 |
0 |
|
Convictions |
0 |
1 |
2 |
We take fraud seriously and prioritize your peace of mind. When you choose Texas Mutual, we’re here to support your business and you can count on our team to investigate suspicious activity. Learn more about how to prevent fraud and help your employees recognize and report fraud with our fraud awareness posters.